> But frankly it’s unsustainable to have all patients on branded drug, it would be too costly for patients and payers.

This is incorrect, the Canadian healthcare system negotiates drug costing at a per province rather than per patient manner and has managed to negotiate down drugs pretty significantly especially in Ontario. A national drug plan doesn't currently exist but it's likely that drug and dental coverage is going to be a goal in the near term.

In the US there is also a complex drug reimbursement program run by most manufacturers to offer rebates to patients in the form of trial cards or direct refunds that does help widen accessibility but those programs are generally limited to patients on private insurance due to the nature of incentives and, well, greed.

I think it's very fair to say "Within this current system brand name drugs are a ridiculous ask for most patients due to the availability of generic alternatives" but the system itself is deeply broken. Generics are sometimes whitelabeled versions of the same product but often what are considered inactive ingredients may be modified significantly from brand name versions leading to issues, especially when it comes to neurological drugs, of drastically different effects to patients. The brand name vs. generic problem is a lot more complex than most people give it credit for and while patients should always prefer generics when they're similarly functional there are very notable scenarios where they are not equivalent for treatment. This comment shouldn't be read in direct opposition to the full comment above as this drug is outside my wheelhouse but rather as a comment on generics in general.

Source: I work in a company that analyzes drug pricing and, more generally, comparative insurance reimbursement for a living.